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—PEC-08-03 14:59 FROM-GOLDER ASSOC +949-583-2770 T-404 P.02/02 F-034 DATE RECEIV D EHD LOG NUM BE �l � � `„� _'11 { SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT v 304 E Weber Ave 3rd Floor Stockton, CA 95205 1^ f i)E ' nn{ I ` r20!)) 46%'3"420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd CiJ� .visit JI U I "f-1;_i,I I VIQ�J( BLIC RECORDS RELEASE/ APPLICATION APPLICANT: ICYIS'�ln b)oser BUSINESS/AGENCY: GOWe, 14, Soc,'& O4 _Lt ADDRESS: i S'I`,p- 6 nL IV 'I e I C/} L(2-6 1�' PHONE: +iii- 583-2-100 FACSIMILE: 91-N-5 3-Z7-lO +r TENTATIVE'APPOINTMENT DATE: Le arc Co 1{ Time; r y 1 ' r (Please allow 10 business days from dale of application submittal^ CHECK BOX TO EXPEDITE REQUEST- 3.00 FEE-RECAST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT _ DATE /2 / o 3 7 Department Use Only FILE ADDRESS UNIT vnel feB ❑ Unit 1 j2.-�Ui"v3 a Slrcei S .e RI1 C0� GI EIC tM+ Su- S �J ❑ U s seal S5 (h• t S k An ata cu RhvAcec( �n omtCF TMA lx4 U \\ ✓ v 6. Slmel Cit 7 sl®ei tilP 1A Unit 4 9 SVem 9 Smug 'o. Sveel PI _ El Unit 5 ENVIRONMENTAL HEALTH DEPARTMENT FILES UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT DQ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS ''�❑j TATTOO/BODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to the address indicated above. 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10)days after receipt of application. The files will be held for a maxifrtum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same Condition as released will be reorganized by EHD staff at the expense of the applicant Future file reviews by the same applicant may require a $93.00 deposit prior to review. 5. *TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX INITIALS REVIEWED YES NO REVIEW DATE EMD tbe3-0efi era.iaae 0 tl•.42r''�